|
IMPORTANT INFORMATION: New 2008 Medicare Physician Fee Schedule Payment Rates Effective for Dates of Service July 1, 2008 through December 31, 2008 The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. As a result, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with a 0.5 percent update, retroactive to July 1, 2008. Physicians, non-physician practitioners and other providers of services paid under the MPFS should begin to receive payment at the 0.5 % update rates in approximately 10 business days, or less. Medicare contractors are currently working to update their payment system with the new rates. In the meantime, to avoid a disruption to the payment of claims for physicians, non-physician practitioners and other providers of services paid under the MPFS, Medicare contractors will continue to process the claims that have been on hold on a rolling basis (first in/first out) for payment at the -10.6% update level. After your local contractor begins to pay claims at the new 0.5% rate, to the extent possible, the contractor will begin to automatically reprocess any claims paid at the lower rates. Under the Medicare statute, Medicare pays the lower of submitted charges or the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1 – June 30, 2008, fee schedule amount will be automatically reprocessed. Any lesser amount will require providers to contact their local contractor for direction on obtaining adjustments. Non-participating physicians who submitted unassigned claims at the reduced nonparticipation amount also will need to request an adjustment. Contractor websites are being updated with the new rates and these should be available shortly. Be aware that any published MLN Matters articles affected by the new law will be revised or rescinded as appropriate. Finally, be on the alert for more information about other legislative provisions which may affect you. Further instructions regarding other provisions of MIPPA will be forthcoming. ---------------------------------------------------------------------------- The information that is provided on the physician fee schedule (PFS) web page relates to payment under the PFS and related information concerning the development of the payment amounts. This information is intended for physicians/non-physicians who provide services to Medicare beneficiaries. This information is updated on regular basis when there are payment/policy changes. The formula for calculating 2008 physician fee schedule payment amount is as follows: 2008 Non-Facility Pricing Amount = ((Work RVU * Budget Neutrality Adjustor (0.8806)) (round product to two decimal places) * Work GPCI) + (Transitioned Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor 2008 Facility Pricing Amount = ((Work RVU * Budget Neutrality Adjustor (0.8806)) (round product to two decimal places) * Work GPCI) + (Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor (Note: When applying the 0.8806 work adjustor to the work RVU you must round the product to two decimal places.) PHYSICIAN CENTER
For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) physicians, go to the Physician Center (see under "Related Links Inside CMS" below).
Page Last Modified: 07/16/2008 12:10:52 PM
Help with File Formats and Plug-Ins
Submit Feedback
|
Email
Print